Reset Form

UCC FINANCING STATEMENT

State Form 50181 (R2 / 5-13)
Approved by State Board of Accounts, 2013

FOLLOW INSTRUCTIONS.
A. NAME & PHONE OF CONTACT AT FILER (optional)

B. E-MAIL CONTACT AT FILER (optional)

C. SEND ACKNOWLEDGMENT TO: (Name and Address)

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY.

1. DEBTOR'S NAME: Provide only one Debtor name (1a or 1b) (Use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name.); if any part of the Individual Debtors
name will not fit in line 1b, leave all of item 1 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad).

1a. ORGANIZATION'S NAME

OR
1b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

1c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

2. DEBTOR'S NAME: Provide only one Debtor name (2a or 2b) (Use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name.); if any part of the Individual Debtors
name will not fit in line 2b, leave all of item 2 blank, check here and provide the Individual Debtor information in item 10 of the Financing Statement Addendum (Form UCC1Ad).

2a. ORGANIZATION'S NAME

OR
2b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

2c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

3. SECURED PARTY'S NAME (or NAME of ASSIGNEE of ASSIGNOR SECURED PARTY): Provide only one Secured Party name (3a or 3b).
3a. ORGANIZATION'S NAME

OR
3b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

3c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

4. COLLATERAL: This financing statement covers the following collateral:

5. Check only if applicable and check only one box: Collateral is held in a Trust (see UCC1Ad, item 17 and Instructions) being administered by a Decedents Personal Representative
6a. Check only if applicable and check only one box: 6b. Check only if applicable and check only one box:
Public-Finance Transaction Manufactured-Home Transaction A Debtor is a Transmitting Utility Agricultural Lien Non-UCC Filing

7. ALTERNATIVE DESIGNATION (if applicable): Lessee/Lessor Consignee/Consignor Seller/Buyer Bailee/Bailor Licensee/Licensor

8. OPTIONAL FILER REFERENCE DATA:

UCC FINANCING STATEMENT (Form UCC1) (Rev. 04/20/11)

 Instructions for UCC Financing Statement (Form UCC1)

Fees Worksheet
1. First two (2) pages are $4.00 $ 4.00
2. Enter $4.00 if there are more than two (2) pages; otherwise, enter $0.00 $ ______________ .00
Total (Pay this amount.) $ ______________ .00
NOTE: A statement filed in connection with a public finance transaction or mobile home transaction is $8.00.

Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions, especially Instruction 1; use of the correct name
for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.
Send completed form and any attachments to the filing office, with the required fee.
ITEM INSTRUCTIONS
A and B. To assist filing offices that might wish to communicate with filer, filer may provide information in item A and item B. These items are optional.
C. Complete item C if filer desires an acknowledgment sent to them. If filing in a filing office that returns an acknowledgment copy furnished by filer,
present simultaneously with this form the Acknowledgment Copy or a carbon or other copy of this form for use as an acknowledgment copy.
1. Debtors name. Carefully review applicable statutory guidance about providing the debtors name. Enter only one Debtor name in item 1 -- either
an organization's name (1a) or an individuals name (1b). If any part of the Individual Debtors name will not fit in line 1b, check the box in item 1,
leave all of item 1 blank, check the box in item 9 of the Financing Statement Addendum (Form UCC1Ad) and enter the Individual Debtor name in
item 10 of the Financing Statement Addendum (Form UCC1Ad). Enter Debtors correct name. Do not abbreviate words that are not already
abbreviated in the Debtors name. If a portion of the Debtors name consists of only an initial or an abbreviation rather than a full word, enter only
the abbreviation or the initial. If the collateral is held in a trust and the Debtor name is the name of the trust, enter trust name in the Organizations
Name box in item 1a.
1a. Organization Debtor Name. Organization Name means the name of an entity that is not a natural person. A sole proprietorship is not an
organization, even if the individual proprietor does business under a trade name. If Debtor is a registered organization (e.g., corporation, limited
partnership, limited liability company), it is advisable to examine Debtors current filed public organic records to determine Debtor's correct name.
Trade name is insufficient. If a corporate ending (e.g., corporation, limited partnership, limited liability company) is part of the Debtors name, it must
be included. Do not use words that are not part of the Debtors name.
1b. Individual Debtor Name. Individual Name means the name of a natural person; this includes the name of an individual doing business as a sole
proprietorship, whether or not operating under a trade name. The term includes the name of a decedent where collateral is being administered by
a personal representative of the decedent. The term does not include the name of an entity, even if it contains, as part of the entitys name, the
name of an individual. Prefixes (e.g., Mr., Mrs., Ms.) and titles (e.g., M.D.) are generally not part of an individual name. Indications of lineage (e.g.,
Jr., Sr., III) generally are not part of the individuals name, but may be entered in the Suffix box. Enter individual Debtors surname (family name)
in Individuals Surname box, first personal name in First Personal Name box, and all additional names in Additional Name(s)/Initial(s) box.
If a Debtors name consists of only a single word, enter that word in Individuals Surname box and leave other boxes blank.
For both organization and individual Debtors. Do not use Debtors trade name, DBA, AKA, FKA, division name, etc. in place of or combined with
Debtors correct name; filer may add such other names as additional Debtors if desired (but this is neither required nor recommended).
1c. Enter a mailing address for the Debtor named in item 1a or 1b.
2. Additional Debtors name. If an additional Debtor is included, complete item 2, determined and formatted per Instruction 1. For additional Debtors,
attach either Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP) and follow Instruction 1 for determining and formatting additional
names.
3. Secured Partys name. Enter name and mailing address for Secured Party or Assignee who will be the Secured Party of record. For additional
Secured Parties, attach either Addendum (Form UCC1Ad) or Additional Party (Form UCC1AP). If there has been a full assignment of the initial
Secured Partys right to be Secured Party of record before filing this form, either (1) enter Assignor Secured Partys name and mailing address in
item 3 of this form and file an Amendment (Form UCC3) [see item 5 of that form]; or (2) enter Assignees name and mailing address in item 3 of
this form and, if desired, also attach Addendum (Form UCC1Ad) giving Assignor Secured Partys name and mailing address in item 11.
4. Collateral. Use item 4 to indicate the collateral covered by this financing statement. If space in item 4 is insufficient, continue the collateral
description in item 12 of the Addendum (Form UCC1Ad) or attach additional page(s) and incorporate by reference in item 12 (e.g., See Exhibit A).
Do not include social security numbers or other personally identifiable information.
Note: If this financing statement covers timber to be cut, covers as-extracted collateral, and/or is filed as a fixture filing, attach Addendum (Form
UCC1Ad) and complete the required information in items 13, 14, 15, and 16.
5. If collateral is held in a trust or being administered by a decedents personal representative, check the appropriate box in item 5. If more than one
Debtor has an interest in the described collateral and the check box does not apply to the interest of all Debtors, the filer should consider filing a
separate Financing Statement (Form UCC1) for each Debtor.
6a. If this financing statement relates to a Public-Finance Transaction, Manufactured-Home Transaction, or a Debtor is a Transmitting Utility, check
the appropriate box in item 6a. If a Debtor is a Transmitting Utility and the initial financing statement is filed in connection with a Public-Finance
Transaction or Manufactured-Home Transaction, check only that a Debtor is a Transmitting Utility.

6b. If this is an Agricultural Lien (as defined in applicable states enactment of the Uniform Commercial Code) or if this is not a UCC security interest
filing (e.g., a tax lien, judgment lien, etc.), check the appropriate box in item 6b and attach any other items required under other law.
7. Alternative Designation. If filer desires (at filer's option) to use the designations lessee and lessor, consignee and consignor, seller and buyer
(such as in the case of the sale of a payment intangible, promissory note, account or chattel paper), bailee and bailor, or licensee and licensor
instead of Debtor and Secured Party, check the appropriate box in item 7.
8. Optional Filer Reference Data. This item is optional and is for filer's use only. For filer's convenience of reference, filer may enter in item 8 any
identifying information that filer may find useful. Do not include social security numbers or other personally identifiable information.
UCC FINANCING STATEMENT ADDENDUM
Part of State Form 50181 (R2 / 5-13)
Approved by State Board of Accounts, 2013

FOLLOW INSTRUCTIONS.

9. NAME OF FIRST DEBTOR: Same as line 1a or 1b on Financing Statement; if line 1b was left blank
because Individual Debtor name did not fit, check here.

9a. ORGANIZATION'S NAME

OR
9b. INDIVIDUAL'S SURNAME

FIRST PERSONAL NAME

ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY.

10. DEBTOR'S NAME: Provide (10a or 10b) only one additional Debtor name or Debtor name that did not fit in line 1b or 2b of the Financing Statement (Form UCC1) (Use exact, full name;
do not omit, modify, or abbreviate any part of the Debtors name.) and enter the mailing address in line 10c.

10a. ORGANIZATION'S NAME

OR
10b. INDIVIDUAL'S SURNAME

INDIVIDUALS FIRST PERSONAL NAME

INDIVIDUALS ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

10c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

11. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME: Provide only one name (11a or 11b).
11a. ORGANIZATION'S NAME

OR
11b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

11c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

12. ADDITIONAL SPACE FOR ITEM 4 (Collateral) :

13. This FINANCING STATEMENT is to be filed [for record] (or recorded) in the 14. This FINANCING STATEMENT:
REAL ESTATE RECORDS (if applicable).
covers timber to be cut covers as-extracted collateral is filed as a fixture filing
15. Name and address of a RECORD OWNER of real estate described in item 16 16. Description of real estate:
(if Debtor does not have a record interest):

17. MISCELLANEOUS:

UCC FINANCING STATEMENT ADDENDUM (Form UCC1Ad) (Rev. 04/20/11)

 Instructions for UCC Financing Statement ADDENDUM (Form UCC1Ad)
Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions; use of the correct name for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.

ITEM INSTRUCTIONS

9. Name of first Debtor. Enter name of first Debtor exactly as shown in item 1 of Financing Statement (Form UCC1) to which this Addendum relates.
The name will not be indexed as a separate debtor. The Debtor name in this section is intended to cross-reference this Addendum with the related
Financing Statement (Form UCC1).

If the box in item 1 of the Financing Statement (Form UCC1) was checked because Individual Debtor name did not fit, the box in item 9 of this
Addendum should be checked.

10. Additional Debtors name. If this Addendum adds an additional Debtor, complete item 10 in accordance with Instruction 1 of Financing
Statement (Form UCC1). For additional Debtors, attach either an additional Addendum or Additional Party (Form UCC1AP) and follow Instruction
1 of Financing Statement (Form UCC1) for determining and formatting additional names.

11. Additional Secured Partys name or Assignor Secured Partys name. If this Addendum adds an additional Secured Party, complete item 11
in accordance with Instruction 3 of Financing Statement (Form UCC1). For additional Secured Parties, attach either an additional Addendum
or Additional Party (Form UCC1AP) and complete applicable items in accordance with Instruction 3 of Financing Statement (Form UCC1). In
the case of a full assignment of the Secured Partys interest before the filing of this financing statement, if filer has provided the name and mailing
address of the Assignee in item 3 of Financing Statement (Form UCC1), filer may enter Assignor Secured Partys name and mailing address in
item 11.

12. Additional Collateral Description. If space in item 4 of Financing Statement (Form UCC1) is insufficient or additional information must be
provided, enter additional information in item 12 or attach additional page(s) and incorporate by reference in item 12 (e.g., See Exhibit A). Do
not include social security numbers or other personally identifiable information.

13-16. Real Estate Record Information. If this Financing Statement is to be filed in the real estate records and covers timber to be cut, covers as-
extracted collateral, and/or is filed as a fixture filing, complete items 1-4 of the Financing Statement (Form UCC1), check the box in item 13, check
the appropriate box in item 14, and complete the required information in items 15 and 16. If the Debtor does not have an interest of record, enter
the name and address of the record owner in item 15. Provide a sufficient description of real estate in accordance with the applicable law of the
jurisdiction where the real estate is located in item 16. If space in items 15 or 16 is insufficient, attach additional page(s) and incorporate by
reference in items 15 or 16 (e.g., See Exhibit A), and continue the real estate record information. Do not include social security numbers or other
personally identifiable information.

17. Miscellaneous. Under certain circumstances, additional information not provided on the Financing Statement (Form UCC1) may be required.
Also, some states have non-uniform requirements. Use this space or attach additional page(s) and incorporate by reference in item 17 (e.g., See
Exhibit A) to provide such additional information or to comply with such requirements; otherwise, leave blank. Do not include social security
numbers or other personally identifiable information.
UCC FINANCING STATEMENT ADDITIONAL PARTY
Part of State Form 50181 (R2 / 5-13)
Approved by State Board of Accounts, 2013

FOLLOW INSTRUCTIONS.

18. NAME OF FIRST DEBTOR: Same as line 1a or 1b on Financing Statement; if line 1b was left blank
because Individual Debtor name did not fit, check here.

18a. ORGANIZATION'S NAME

OR
18b. INDIVIDUAL'S SURNAME

FIRST PERSONAL NAME

ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY.

19. ADDITIONAL DEBTOR'S NAME : Provide only one Debtor name (19a or 19b) (Use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name.)
19a. ORGANIZATION'S NAME

OR
19b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

19c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

20. ADDITIONAL DEBTOR'S NAME: Provide only one Debtor name (20a or 20b) (Use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name.)
20a. ORGANIZATION'S NAME

OR
20b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

20c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

21. ADDITIONAL DEBTOR'S NAME: Provide only one Debtor name (21a or 21b) (Use exact, full name; do not omit, modify, or abbreviate any part of the Debtors name.)
21a. ORGANIZATION'S NAME

OR
21b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

21c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

22. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME: Provide only one name (22a or 22b).
22a. ORGANIZATION'S NAME

OR
22b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

22c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

23. ADDITIONAL SECURED PARTY'S NAME or ASSIGNOR SECURED PARTY'S NAME: Provide only one name (23a or 23b).
23a. ORGANIZATION'S NAME

OR
23b. INDIVIDUAL'S SURNAME FIRST PERSONAL NAME ADDITIONAL NAME(S)/INITIAL(S) SUFFIX

23c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY

24. MISCELLANEOUS:

UCC FINANCING STATEMENT ADDITIONAL PARTY (Form UCC1AP) (Rev. 08/22/11)

 Instructions for UCC Financing Statement Additional Party (Form UCC1AP)
Please type or laser-print this form. Be sure it is completely legible. Read and follow all Instructions; use of the correct name for the Debtor is crucial.
Fill in form very carefully; mistakes may have important legal consequences. If you have questions, consult your attorney. The filing office cannot give
legal advice.
Use this form (multiple copies if needed) to continue adding additional Debtor or Secured Party names as needed when filing a UCC Financing Statement
(Form UCC1).

ITEM INSTRUCTIONS

18. Name of first Debtor. Enter name of first Debtor exactly as shown in item 1 of Financing Statement (Form UCC1) to which this Additional Party
relates. The name will not be indexed as a separate Debtor. If line 1b of the Financing Statement (Form UCC1) was left blank because the Individial
Debtor name did not fit, check the box in item 18 and enter as much of the Individual Debtor name from item 10 that will fit. The Debtor name
in this section is intended to cross-reference this Additional Party with the related Financing Statement (Form UCC1).

19-21. Additional Debtors name. If this Additional Party adds additional Debtors, complete items 19, 20, and 21 in accordance with Instruction 1 of
Financing Statement (Form UCC1).

22-23. Additional Secured Partys name or Assignor Secured Partys name. If this Additional Party form adds additional Secured Parties, complete
items 22 and 23 in accordance with Instruction 3 of Financing Statement (Form UCC1). In the case of a full assignment of the Secured Partys
interest before the filing of this financing statement, if filer has provided the name and mailing address of the Assignee in item 3 of Financing
Statement (Form UCC1), filer may enter Assignor Secured Partys name and mailing address in items 22 and 23.

24. Miscellaneous. Under certain circumstances, additional information not provided on the Financing Statement (Form UCC1) may be required.
Also, some states have non-uniform requirements. Use this space or attach additional page(s) and incorporate by reference in item 24 (e.g., See
Exhibit A) to provide such additional information or to comply with such requirements; otherwise, leave blank. Do not include social security
numbers or other personally identifiable information.